Emergency Service, Hospital Clinical Trial
Official title:
SatCare: Remote Support for Ambulance Clinicians in Medical Emergencies
Verified date | February 2021 |
Source | University of Aberdeen |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
SatCare is a randomised controlled trial involving rapid standardised ultrasound assessment of patients with shock, major trauma, abdominal pain, chest pain or breathlessness in emergency ambulances. The scans will take less than 5 minutes and be transmitted to a hospital-based expert for review, providing support and instructions for optimal prehospital care. Five Highland Scottish Ambulance Service ambulances covering areas more than 30 minutes from Raigmore Hospital, Inverness, UK, will be equipped with an ultrasound machine (M-Turbo, FujiFilm Sonosite) and satellite transmission system plus webcam, and will be deployed in real emergency situations. When dispatched to a potentially eligible patient, the attending paramedic will contact Raigmore Hospital's emergency department to check the availability of an emergency medicine specialist and obtain study group allocation (ultrasound with enhanced telecommunications plus usual care versus usual care alone). Following verbal consent from the patient, trained paramedics will perform the condition-specific scan protocol in the ambulance at the incident site, and transmit the recordings and patient video via satellite to the emergency department for specialist analysis. The consultant will give advice on patient management via standard ambulance communications systems while it is en route to the hospital. The remotely supported prehospital ultrasound implementation will be examined in terms of its delivery and functioning. An economic evaluation will compare its use with care as usual for eligible patients transported by ambulance, modelling the costs and benefits of this service expansion and determining optimum use. It is hoped that the results, anticipated to be available in 2019, will provide an evidence base for the use of prehospital ultrasound for emergency care.
Status | Completed |
Enrollment | 57 |
Est. completion date | January 31, 2019 |
Est. primary completion date | April 1, 2018 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 16 Years and older |
Eligibility | Inclusion Criteria: - Patients with: - significant trauma: any case where the mechanism of injury, anatomical defect or physiological upset triggers the paramedic to pre-alert a 'trauma call' to the receiving Emergency Department - chest pain: pain felt below the clavicles and above the costal margin, whether anterior or posterior - shortness of breath: any patient complaining of 'shortness of breath' or with paramedic examination positive for 'respiratory distress' whether by increased respiratory rate, effort or both - abdominal pain: any pain felt below the costal margin and above the bony pelvis - cardiovascular shock of unknown origin: either a systolic blood pressure below 100 mmHg or any symptoms or signs of syncope on elevation of the head, cool peripheries or extended capillary refill time - Attended by a study ambulance - Recruitment occurs within the hours supported by the Emergency Department: Monday to Friday, 09:00 to 17:00 Exclusion Criteria: - Non-emergency ambulance transfers - General practitioner requested emergency ambulances - Patients under arrest or held in prison - No potential value in performing ultrasound (e.g., none of the diagnoses listed above) - Lack of consent for scan (if in intervention arm) - Lack of capacity to consent to scan / no patient representative to provide consent - Evidence of any condition leading to lack of capacity to give informed consent prior to the commencement of the study, as documented on the patient's electronic patient record - Non-English speakers - Outside the emergency department supported hours (Monday to Friday, 09:00 to 17:00) - Paramedic decision to exclude patient, for reasons such as urgency of transport (i.e., where thorough on-scene evaluation would not normally be offered) or other lack of suitability |
Country | Name | City | State |
---|---|---|---|
United Kingdom | Centre for Rural Health | Inverness | Scotland |
United Kingdom | NHS Highland: Raigmore Hospital | Inverness | Scotland |
United Kingdom | Scottish Ambulance Service | Inverness | Scotland |
Lead Sponsor | Collaborator |
---|---|
University of Aberdeen | NHS Highland, Scottish Ambulance Service |
United Kingdom,
Eadie L, Mulhern J, Regan L, Mort A, Shannon H, Macaden A, Wilson P. Remotely supported prehospital ultrasound: A feasibility study of real-time image transmission and expert guidance to aid diagnosis in remote and rural communities. J Telemed Telecare. 2018 Oct;24(9):616-622. doi: 10.1177/1357633X17731444. Epub 2017 Sep 18. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | EQ-5D-5L (EuroQol five dimension, five level) score three months after the initial ambulance episode | The EQ-5D-5L questionnaire includes assessments of mobility, self-care, daily activities undertaken, pain, discomfort, anxiety and depression.Completion of the EQ-5D-5L leads to the establishment of 243 distinct states, each with corresponding numerical quality of life value. | 3 months post recruitment | |
Secondary | Cost per QALY (Quality Adjusted Life Year) | Estimates of cost per QALY are generated using costs and EQ-5D-5L score. The QALY is a measure of disease burden, encompassing both the quality and quantity of life lived. Quality of life is rated between 0 ('worst possible health') and 1 ('best possible health'). The QALY is calculated from the amount of time spent in a particular health state weighted by the utility (quality) score given to that health state.
The QALY gained by a specific treatment is compared with an existing standard or no intervention. The relative costs of the two interventions are then compared and the cost of the new treatment in excess of the standard is calculated. This figure is then divided by the QALY of the new intervention to give the cost per QALY (£ per QALY). Lower costs per QALY are preferred by healthcare systems, as they are thought to provide better value for money. |
3 months post recruitment | |
Secondary | Time from ambulance arrival at scene to definitive treatment or discharge | Measured in hours and minutes | up to 3 months post recruitment | |
Secondary | Mortality rate | up to 3 months post recruitment | ||
Secondary | Process evaluation (to investigate intervention use, acceptance and optimisation) | Includes interviews with stakeholders and anonymised descriptions of cases in which management was altered as a result of the intervention | 15 months | |
Secondary | Costs to the NHS | Covering staff and equipment costs, treatment costs, etc. Costs will be measured in UK Pounds Sterling and compiled into a Total Costs figure to compare costs with/without the intervention. | 15 months | |
Secondary | Relative efficiency calculations (cost-consequences analysis) | A cost-consequences analysis is an economic evaluation where disaggregated costs and a range of outcomes are presented to allow readers to form their own opinion on relevance and relative importance. A descriptive table presents the primary and secondary outcome results together with the estimates of the mean costs associated with each intervention. | 15 months | |
Secondary | Patient and staff satisfaction with the intervention | Collected using custom created questionnaires | 15 months | |
Secondary | Patient and staff satisfaction with the intervention | Collected using custom created interview schedules | 15 months | |
Secondary | Communications system connection speed | The communications system connection speed - the time to locate the satellite, connect to it, and connect to the end server - will be recorded (minutes and seconds). Any failure to connect will be noted. | 15 months | |
Secondary | Communications system data upload rate | Data upload speeds will be recorded (kb/s). | 15 months |
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